Abstract Rationale Plastic bronchitis (PB) is a rare, potentially life-threatening condition characterized by cohesive airway casts that can cause severe obstruction. Conventional bronchoscopic techniques such as suction, lavage, and forceps are often inadequate for removal. The EN Snare® Endovascular Snare System (Merit Medical Systems, South Jordan, UT, USA) is a tri-looped snare composed of stranded platinum (Pt) and nitinol (NiTi) coupled to a flexible NiTi shaft wire. Designed for retrieval of intravascular foreign bodies, its collapsible tri-loop structure and flexible shaft may facilitate safe and effective off-label use in the airway. This study describes our experience using the EN Snare for bronchoscopic removal of airway casts in pediatric and young adult patients with PB. Methods We performed a retrospective review of patients ≤30 years of age who underwent flexible bronchoscopic removal of airway casts using the EN Snare at the Children’s Hospital of Philadelphia between June 2020 and September 2024. Clinical data were extracted from electronic medical records, including demographics, underlying diagnoses, EN Snare size, adjunctive bronchoscopic tools, complications, and outcomes. Descriptive statistics were applied to summarize findings. Results Twenty-three patients underwent 37 EN Snare-assisted bronchoscopies for PB. The median age was 8 years 9 months (range, 1 year 11 months-28 years 4 months). Most patients had congenital heart disease with prior Glenn or Fontan palliation. The Olympus BF-P190 bronchoscope (outer diameter 4.2 mm; channel 2.0 mm) was most frequently used. EN Snare size was documented in 56.8% of procedures; among these, the 3.2 Fr device was used in 32.4% and the 6 Fr device in 24.3%. Additional tools were utilized in 32.4% of bronchoscopies, including cryoprobe (21.6%) and alligator forceps (13.5%). Partial or complete cast removal was achieved in all but one case involving eosinophilic casts. Complications occurred in two procedures: transient airway bleeding controlled with topical oxymetazoline and pneumothorax requiring chest tube placement following a concurrent lymphatic intervention. Conclusion The EN Snare® Endovascular Snare System is a safe, effective, and versatile tool for flexible bronchoscopic removal of airway casts in plastic bronchitis. Its flexible shaft and tri-loop design facilitate en bloc extraction of cohesive lymphatic casts, particularly in patients with congenital heart disease following palliative surgery. While its role may be limited in eosinophilic casts, the EN Snare remains a valuable addition to the bronchoscopist’s armamentarium. Larger, prospective studies are warranted to further define its optimal use and comparative efficacy against other bronchoscopic tools. This abstract is funded by: None
Dutta et al. (Fri,) studied this question.